Internal Analyst

Description

JOB SUMMARY:

 The Internal Analyst performs financial, operational, compliance, and/or investigative audits of the Health System and its related entities; reviews and assesses the effectiveness of internal controls within the organization; prepares and communicates audit findings, conclusions, and recommendations in a timely manner. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. All activities must be in compliance with Equal Employment laws, HIPAA, ERISA and other regulations, as appropriate. 

EDUCATION, CREDENTIALS & EXPERIENCE REQUIREMENTS:

•  High School diploma or equivalent is required.
• Bachelor’s degree in Business, Accounting, Health Care Administration or a related field preferred.
• Healthcare compliance experience or certification preferred.
• Healthcare billing or coding experience preferred.
• Intermediate skills with Microsoft Word, Excel, and Power Point required.
• Critical thinking skills and strong attention to detail required.

GENERAL REQUIREMENTS:

• Performs all job responsibilities in alignment with the mission and vision of the organization.
• Performs other duties as required and completes all job functions as per departmental policies and procedures.
• Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs).
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
• Wears protective clothing and equipment as appropriate.

GENERAL SKILLS:

• Ability to communicate in English, both verbally and in writing.
• Additional languages preferred.
• Strong written and verbal skills.
• Basic Computer Skills

WORKING CONDITIONS:

• General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.
• May be exposed to high noise levels and bright lights.
• May be exposed to limited hazardous substances or body fluids, or infectious organisms.
• May be required to change from one task to another or different nature without loss of efficiency or composure.
• Periods of high stress and fluctuating workloads may occur.
• May be scheduled as needed including overtime.

PHYSICAL REQUIRMENTS & DEMANDS:

• Have near normal hearing: Hear alarms/telephone/normal speaking voice.
• Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors.
• Have good manual dexterity.
• Have good eye-hand foot coordination.
• Ability to perform repetitive tasks/motion.
• Continuously within shift (67-100%): Standing, Walking.
• Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry greater than 20 lbs. with assistance.
• Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry greater than 50 lbs. with assistance, Reaching above shoulder.

MISSION STATEMENT:

QUALITY HEALTHCARE: In our continuing effort to enhance the quality of life for the communities we serve, the Hospital Authority of Miller County is committed to the delivery of superior, safe, cost-effective healthcare through the provisions of education prevention, diagnosis and treatment.

JOB SPECIFIC COMPETENCIES:

• Assist in developing, maintaining and revising policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical or improper conduct
• Assist in instituting and maintaining an effective Compliance Program for the organization including promoting Corporate Standards of Conduct and Corporate Code of Ethics, as well as having a thorough understanding of new and existing compliance issues and their related policies and procedures
• Works closely with internal departments to resolve and research member and provider reconsideration, contacts members, providers and external agencies to obtain additional information to adequately resolve and respond to the reconsiderations and grievances
• Prepare written responses to all complaints and ensures that correspondence appropriately addresses each complainants' issues and is accurate
• Demonstrates an understanding of the functions of other departments and affiliates while communicating appropriately to maintain positive working relationships
• Prepare cases detailing the findings of the investigation for consideration of the Plan's determination
• This position requires a mature, confident individual with excellent writing skills and the ability to focus on assigned tasks to ensure timely completion
• Must be able to analyze and resolve complex issues
• Must possess excellent organizational, problem-solving and analytical skills to enable sound and timely decision
• Must have familiarity with Medicaid and Medicare claims denials and appeals processing as well as knowledge of HIPAA guidelines
• Has the ability and willingness to manage changing priorities and work assignments in support of multiple projects and deadlines
• Analyzes records, reports, regulations and operating practices and issues reports on regulatory control adherence.
• Demonstrate an understanding of the functions of other departments and affiliates while communicating appropriately and collaborating to maintain positive working relationships.
• Prepare cases detailing the findings of investigations for consideration.
• This position requires a mature, confident individual with excellent writing, critical thinking, and communication skills, and the ability to focus on assigned tasks to ensure timely completion.
• Must be able to analyze and resolve complex issues.
• Must possess excellent organizational, problem-solving and analytical skills to enable sound and timely decision making.
• Must demonstrate a strong attention to detail.
• Must have the ability and willingness to manage changing priorities and work assignments in support of multiple projects and deadlines.
• Must be able to prioritize workload effectively and stay organized.
• Analyze records, reports, regulations and operating practices and prepare reports on regulatory control adherence.
• Responsible for implementing and maintaining comprehensive risk-based compliance audits.
• Possess a personal presence that is characterized by a sense of honesty, integrity, and caring.
• Performs all job responsibilities in alignment with the core values, mission, and vision of the organization.
• Performs other duties as required

PROFESSIONAL REQUIREMENTS:

• Follows Code of Conduct policy.
• Adheres to dress code; appearance is neat and clean.
• Completes annual educational requirements.
• Maintains regulatory requirements.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled; completes work within designated time.
• Wears identification when on duty; uses computerized time clock system correctly.
• Completes in-services and returns in a timely fashion.
• Attends annual review and/or skills fair and department in-services, as scheduled.
• Attempts to end conversations and other interactions in a positive manner; leaves others with a good impression of the Hospital Authority of Miller County and its employees.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission statement of the organization.

GUEST RELATIONS STANDARDS:

(All guest relation violations are subject to disciplinary action up to and including termination):

• Always treat others in a friendly, helpful manner.
• Refers co-workers to proper sources when unable to provide an answer.
• Interacts with others in a professional and friendly manner.
• Takes interest in others and always gives full cooperation to fellow workers.
• Always maintains an open line of communication with other departments.
• Thoroughly familiar with the hospital and the services it offers.

OTHER:

• Responsibility to Report: It is the responsibility of every employee of HAMC to comply with federal, state and local laws and regulations, as well as, HAMC Policies and Procedures. Every employee is held accountable to participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected.
• As an employee of HAMC, you have been granted user access to applicable ePHI systems based on your position. This user or role-based access is intended to give you the minimum necessary access to perform your job function(s) only and should be used only as applicable.